Esophagomediastinal fistula: a rare case of gastrointestinal tuberculosis.

A 40-year-old male with history of HIV infection was admitted to the hospital with a one-month history of productive cough, vespertine fever, night sweats, loss of appetite and unintentional 10-Kg weight loss. Physical exam was remarkable for cachexia. Blood tests revealed a CD4+ T lymphocyte count of 23 cells/mm3 and HIV viral load of 837,678 copies/ml. Bacilloscopies were positive. Chest computed thomography (CT) showed multiple mediastinal lymph nodes, signs of esophagomediastinal fistula, pericardial effusion and multiple micronodular pulmonary opacities. Endoscopy (EGD) revealed a 10 mm deep ulcer-like lesion in the middle esophagus with pus overflow, but no bubbles were seen. The diagnosis of stage C3 HIV infection with disseminated tuberculosis was made and the patient underwent standard antituberculosis (RIPE) and antiretroviral therapy. Given the mediastinitis risk a percutaneous endoscopic gastrostomy (PEG) tube was placed for nutritional purposes.

Whipple's disease orbitopathy: case report and review of literature.

A 59-year-old female patient was diagnosed with Whipple's disease (WD) after several months of constitutional complaints and adenopathies that were initially misinterpreted as sarcoidosis. Initial treatment included doxycycline, hydroxychloroquine and prednisolone, which was suspended due to long-term clinical stability. Four months after prednisolone suspension, the patient presented with right periorbital oedema and erythema. Ophthalmological examination revealed restricted eye movements. A computed tomography (CT) scan demonstrated signs of myositis. The patient was treated with anti-inflammatory and antibiotic drugs, that induced remission of the orbitopathy. During the following two years, she presented three relapses, affecting both the right or the left eyes. The last episode was also associated with systemic corticosteroid tapering. Orbitopathy is a rare form of WD presentation and the diagnosis of this condition may be challenging. As the clinical spectrum may range from an incidentaloma to a severe compressive neuropathy, proper recognition and management of WD orbitopathy is essential.

Stride-to-stride fluctuations and temporal patterns of muscle activity exhibit similar responses during walking to variable visual cues.

Incorporating variability within gait retraining approaches has been proposed and shown to lead to positive changes. Specifically, submitting the individuals to walk in synchrony to cues that are temporally organized with a fractal-like patterns, promotes changes at the stride-to-stride fluctuations closer to those typically find in young adults. However, there is still a need to understand the underlying neuromuscular mechanisms associated to such improvement. Thus, this study aimed to investigate whether changes in the temporal structure of the variability in gait patterns are accompanied by changes in muscle activity patterns. Fourteen young individuals walked synchronized to one uncued (UNC) and three cued conditions: isochronous (ISO), fractal (FRC) and random (RND). Inter-stride intervals were determined from an accelerometer placed on the lateral malleoli. Inter-muscle peak intervals were obtained from the electromyographic signal from the gastrocnemius muscle. Fractal scaling, obtained through detrended fluctuation analysis, and coefficient of variation were calculated. Repeated measures ANOVAs were used to identify differences between conditions. Significant main effect was observed for both fractal scaling and coefficient of variation. Both shown no differences between UNC and FRC conditions, while ISO and RND were significantly lower compared to UNC and FRC conditions. In addition, a Pearson's Correlation was used to test the correlation between variables. A strong correlation was found the temporal structure of gait and muscle activity patterns. These findings strengthen the current literature regarding the incorporation of variability within cued approaches. Specifically, it shows that such an approach allows the modification of the neuromuscular processes underlying the stride-to-stride fluctuations.

Muscle activity variability patterns and stride to stride fluctuations of older adults are positively correlated during walking.

It has been found that fractal-like patterns are present in the temporal structure of the variability of healthy biological rhythms, while pathology and disease lead to their deterioration. Interestingly, it has recently been suggested that these patterns in biological rhythms are related with each other, reflecting overall health or lack of it, due to their interaction. However, the underlying neurophysiological mechanisms responsible for such dependency remain unknown. In addition, this relationship between different elements needs to be first verified before we even pursue understanding their interaction. This study aimed to investigate the relationship between two elements of the neuromuscular system, gait and muscle activity variability patterns in older adults. Twenty-one older adults walked at their preferred walking speed on a treadmill. Inter-stride intervals were obtained through an accelerometer placed on the lateral malleoli to assess the temporal structure of variability of stride-to-stride fluctuations. Inter muscle peak intervals were obtained through the electromyographic signal of the gastrocnemius to assess the temporal structure of the variability of the simultaneous muscle activity. The temporal structure of variability from both signals was evaluated through the detrended fluctuation analysis, while their magnitude of variability was evaluated using the coefficient of variation. The Pearson's Correlation coefficient was used to identify the relationship between the two dependent variables. A significant strong positive correlation was found between the temporal structure of gait and muscle activity patterns. This result suggests that there is an interdependency between biological rhythms that compose the human neuromuscular system.

Pulmonary nocardiosis: A Single Center Study.

OBJECTIVES: Nocardiosis is a rare infection caused by Nocardia spp., a gram-positive bacteria non-commensal of the human flora. Nocardiosis usually presents with lung infection but may disseminate to other organs, most frequently the brain. The major risk factor is immunosuppression, but lung diseases also increase the risk of infection. Treatment with antibiotics is usually prolonged. In this study, we made a retrospective analysis of pulmonary nocardiosis cases and a review of the available literature. METHODS: We made a retrospective analysis of all pulmonary nocardiosis cases from 13 years (January 2005 to December 2017) in our institution, selecting patients from pulmonology and infectious diseases consultation. RESULTS: We found four patients diagnosed with pulmonary nocardiosis, three males (patients 1, 2 and 3) and one female (patient 4). Median age was 71 ± 15 years old. Different specimens were identified (N. cyriacigeorgica, Nocardia spp., N. nova, and N. wallacei/transvalensis). Bronchofibroscopy with bronchoalveolar lavage culture was the most frequent diagnostic procedure (patients 1 and 4). Only patient 2 presented an unfavorable response to treatment and died from septic shock. CONCLUSIONS: Pulmonary nocardiosis has a good prognosis if diagnosed early and treated adequately. It should always be considered in the differential diagnosis of pulmonary infections concomitant with brain or other soft tissue lesion, especially in immunocompromised patients.

A case report of disseminated Mycobacterium colombiense infection in an HIV patient.

Mycobacterium colombiense is a newly recognized member of the Mycobacterium avium complex, and only a few cases of infections caused by this pathogen have been reported. We present an imported case of disseminated disease caused by M. colombiense in an HIV patient in early February 2017.

A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal.

Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.

Actinomycosis, a lurking threat: a report of 11 cases and literature review.

Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.

Dengue virus serotype 3 and Chikungunya virus co-infection in a traveller returning from India to Portugal, November 2016.

We report a case of a laboratory-confirmed Dengue and Chikungunya viruses co-infection imported from India to Portugal in early November 2016. The patient developed fever, retro-orbital pain and generalized myalgia after returning from Delhi, Jaipur, Agra, Rishikesh, Goa and Mumbai. This case highlights the importance of these arboviruses to public health in India where high rates of co-infection have been reported in the last few years, and demonstrates how challenging the laboratory diagnosis of imported co-infection cases can be in non-endemic areas.

A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal

Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.

Actinomycosis, a lurking threat: a report of 11 cases and literature review

Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.